J Korean Assoc Oral Maxillofac Surg.  2010 Jun;36(3):217-220. 10.5125/jkaoms.2010.36.3.217.

Traumatic ulcerative granuloma misjudged as oral squamous cell carcinoma (SCC) on the buccal cheek: case report

• Kwon JI
• Kim HW
• Nam W
• Cha IH
• Kim HJ

• KMID: 2189952
• DOI: http://doi.org/10.5125/jkaoms.2010.36.3.217

Abstract

Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE) is an ulcerative lesion on oral mucosa featuring as a benign mass of self-limiting growth. It can be easily misdiagnosed as squamous cell carcinoma (SCC) due to its long healing period and elevated or rolled-up margin. A 57-year old male patient who visited our department was diagnosed as SCC according to the clinical features, results of positron emission tomography (PET) and magnetic resonance imaging (MRI) of the oral lesion. However, after performing incisional biopsy, histopathologically, there were no atypical cells, but eosinophil and CD 30+ T-cells were clustered in subcutaneous and muscle tissue. It is very significant to consider this reactive lesion in the field of oral and maxillofacial surgery because of its possibility of mistaken as malignant disease. Here, we will report a couple of cases of TUGSE with references and limit of radiographic tools used for diagnosis of head and neck cancer.

Keyword

Traumatic ulcerative granuloma with stromal eosinophilia (TUGSE)

MeSH Terms

Biopsy
Carcinoma, Squamous Cell
Eosinophilia
Eosinophils
Granuloma
Head and Neck Neoplasms
Humans
Magnetic Resonance Imaging
Male
Mouth Mucosa
Muscles
Positron-Emission Tomography
Surgery, Oral
T-Lymphocytes
Ulcer

Figure

• 

  Fig. 1. Intraoral view of Rt. buccal cheek lesion showing rolled-up margin.

• 

  Fig. 2. Panoramic view showing sharp tooth cusp of #15.

• 

  Fig. 3. Coronal and axial MRI showing soft tissue mass on right buccal cheek. (MRI: magnetic resonance imaging)

• 

  Fig. 4. F18-FDG-PET showing uptake of FDG on right buccal cheek and right submandibular area. (F18-FDG-PET: F18-fluorodeoxyglu-cose positron emission tomography)

• 

  Fig. 5. Intraoral view of 1-week after incisional biopsy showing healing of lesion and decrease of mass size.

• 

  Fig. 6. Intraoral view of 1- month after incisional biopsy showing verrucous exophytic mass on primary site.

• 

  Fig. 7. Histologic section.(H&E staining, original magnification ×100 (left), ×400 (right)) TUGSE is characterized by infiltrated eosinophils in muscle tissue and abundant inflammatory cell on mucosa and connective tissue. But there is no basal cell dysplasia. (TUGSE: traumatic ulcerative granuloma with stromal eosinophilia)

Reference

References

1. Hirshberg A, Amariglio N, Akrish S, Yahalom R, Rosenbaum H, Okon E, et al. Traumatic ulcerative granuloma with stromal eosinophilia: a reactive lesion of the oral mucosa. Am J Clin Pathol. 2006; 126:522–9.

2. Boffano P, Gallesio C, Campisi P, Roccia F. Traumatic ulcerative granuloma with stromal eosinophilia of the retromolar region. J Craniofac Surg. 2009; 20:2150–2.

3. Elovic AE, Gallagher GT, Kabani S, Galli SJ, Weller PF, Wong DT. Lack of TGF-alpha and TGF-beta 1 synthesis by human eosinophils in chronic oral ulcers. Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 1996; 81:672–81.

4. Regezi JA, Zarbo RJ, Daniels TE, Greenspan JS. Oral traumatic granuloma. Characterization of the cellular infiltrate. Oral Surg Oral Med Oral Pathol. 1993; 75:723–7.

5. Ficarra G, Prignano F, Romagnoli P. Traumatic eosinophilic granuloma of the oral mucosa: a CD30+(Ki-1) lymphoproliferative disorder? Oral Oncol. 1997; 33:375–9.

6. Elzay RP. Traumatic ulcerative granuloma with stromal eosinophilia (Riga-Fede’ s disease and traumatic eosinophilic granuloma). Oral Surg Oral Med Oral Pathol. 1983; 55:497–506.

7. Salisbury CL, Budnick SD, Li S. T-cell receptor gene rearrangement and CD30 immunoreactivity in traumatic ulcerative granuloma with stromal eosinophilia of the oral cavity. Am J Clin Pathol. 2009; 132:722–7.

8. Segura S, Romero D, Mascaro JM Jr, Colomo L, Ferrando J, Estrach T. Eosinophilic ulcer of the oral mucosa: another histological simulator of CD30+ lymphoproliferative disorders. Br J Dermatol. 2006; 155:460–3.